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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409179
Report Date: 08/23/2022
Date Signed: 08/23/2022 06:29:50 PM

Document Has Been Signed on 08/23/2022 06:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MOKTAN, SHRADAFACILITY NUMBER:
073409179
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
08/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Shrada MoktanTIME COMPLETED:
06:45 PM
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On 8/23/2022 at 3:30PM, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Shrada Moktan for an Unannounced Required Annual Inspection. Present during the inspection was five infants, one preschooler and one school age child( licensee's child) in care. Residing in the home is Licensee, her fingerprint cleared husband, her school age child and preschooler. Licensee’s home was toured for a health and safety inspection. The facility operates 7:30am – 6:00pm, Monday - Friday.

The home is a single-story home that consists of four bedrooms and two bathrooms. The entrance to the day is the front door. The inside and outside of the home were observed to be neat, clean with age appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions, there is a fireplace in the living room that is covered by the couch, cabinets and drawers in the kitchen have safety latches and the off-limit areas are closed to prevent access. Licensee has stated that there are no firearms and no pets in the home.


ON LIMITS AREA: Kitchen, Living Room (main day care area), Dining Area, the bathroom next to the living room, the first bedroom on the left side of the hallway and the bedroom on the right side of the hallway and parts of the backyard.
OFF LIMITS AREA: 2nd bedroom on the left side of the hallway, the bedroom and bathroom off the kitchen area, the converted garage, the fenced in swimming pool, and the left side of the backyard when facing the house, which will be inaccessible by closed and/or locked doors or visual supervision.
ISOLATION AREA: will the 1st bedroom on left side of the hall
The home has a fully charged 3A40BC fire extinguisher located in the hallway and a working smoke detector and carbon monoxide detector in the main area of the day care. Licensee has a working telephone and complete First Aid Kit. All required forms are posted and visible for public view in the childcare room. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 5/20/21. Report continues on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MOKTAN, SHRADA
FACILITY NUMBER: 073409179
VISIT DATE: 08/23/2022
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The Licensee's CPR and First Aid certificate is current and expires on 2/12/2023. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for which was conducted on 03/7/22. There is a swimming pool in the backyard that is not being used and is locked and gated.
LPA reviewed seven the children’s files, two staff files and obtained a copy of the facility roster, all were files were complete and current.

The following was observed during today’s inspection:
- At 3:31PM LPA Fernandes observed seven children in care, five infants, one preschooler and a school age child in care.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

NO IMS IS BEING PROVIDED.AS OF TODAY

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MOKTAN, SHRADA
FACILITY NUMBER: 073409179
VISIT DATE: 08/23/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgment form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative Shrada Moktan

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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Document Has Been Signed on 08/23/2022 06:29 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 08/23/2022 at 05:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MOKTAN, SHRADA
FACILITY NUMBER: 073409179

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5
Staffing Ratio and Capacity For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
(1) Four infants; or (2) Six children, no more than three of whom may be infants; or (3)More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above there were not within ratio which poses an immediate safety risk to persons in care.
POC Due Date: 08/24/2022
Plan of Correction
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Licensee is to bring the home back into ratio and provide a plan to CCL of which children will be let go in order to bring the home back into compliance, by proof of correction date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022


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